Aspectos epidemiológicos da Leishmaniose Tegumentar Americana na região Noroeste do Estado do Paraná / Epidemiological aspects of American Cutaneous Leismaniasis in the northwest region of the state of Paraná

No Estado do Paraná, a primeira notificação de leishmaniose tegumentar americana ocorreu em 1917 e a partir de 1980 observou-se um aumento do número de casos, mantendo-se endêmica e acometendo pessoas de todas as faixas etárias e em ambos os sexos. Este estudo teve como objetivo realizar um levantamento epidemiológico sobre a ocorrência de LTA em pacientes atendidos no Laboratório de Ensino e Pesquisa em Análises Clínicas da Universidade Estadual de Maringá (LEPAC/UEM). Foi realizado um estudo retrospectivo e descritivo em base de dados secundário de 1986 a 2005, com 1656 pacientes segundo as variáveis: sexo, idade, ocupação, procedência, local de moradia, forma clínica e diagnóstico. A maioria dos pacientes era do sexo masculino (72,6%) e adquiriu a infecção no Estado do Paraná (97,8%), residia em área urbana (64,3%) dos quais 51,3% adquiriu a infecção durante atividades de lazer. O diagnóstico da maioria dos pacientes foi estabelecido nos dois primeiros meses de evolução das lesões (54,0%) e apresentando a forma cutânea da doença (88,9%). Uma parcela (34,4%) significativa dos pacientes que residiam em área rural adquiriu a infecção no domicílio ou peridomicílio. O estudo mostra a predominância da forma cutânea da leishmaniose tegumentar americana e sugere a atividade de lazer e o ambiente do domicilio como fatores preditivos importantes para a infecção.

The first notification of American cutaneous Leishmaniasis (LTA) in the state of Paraná, Brazil, occurred in 1917 and an increasing number of cases has been reported since 1980. This parasitic skin disease, spread by the bite of infected sandflies, is still an endemic problem, with recurrence in both sexes and in all age groups. The objective of this study was to perform a survey on the occurrence of American cutaneous Leishmaniasis in patients attended at the Teaching and Research Clinical Analysis laboratory at the State University of Maringá (LEPAC/UEM). A retrospective and descriptive study was carried out, based on secondary data (1986-2005) on 1656 patients, relating to their sex, age and occupation and the origin, clinical forms and positive diagnosis of the disease. Most of the patients were male (72.6%), lived in the urban area (64.3%) and acquired the infection during outdoor leisure activities (51.3%) in the State of Paraná (97.8%). The cutaneous form of the infection predominated (88.9%) and the diagnosis was made in the first two months of development of the lesions (54.0%). A significant part (34.4%) of the patients who lived in the rural area acquired the infection inside or close to their homes. The study shows the predominance of the cutaneous form of American cutaneous Leishmaniasis and suggests that leisure activity and housing conditions could be useful predictive factors for the infection.

Hepatitis C: serological and molecular diagnosis and genotype in haemophilic patients at the Regional Hemocenter of Maringá, Maringá PR Brazil.

Prior to the process of viral inactivation in the 1980s most haemophilic patients were infected with hepatitis C virus, currently one of the disease's main causes. The prevalence of infection by hepatitis C virus in haemophilic patients enrolled in the Hemocenter of the Regional University Hospital maintained by the State University of Maringá is evaluated from social and epidemiologic data and from serum and molecular tests. Possible association between haemophilia's type and severity, type of treatment, data of start of treatment and hepatic enzyme rates of Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) was verified. Sixty-nine haemophilic patients, 82.6% with haemophilia A and 17.4% with haemophilia B, in the 1 - 67 years age bracket, average age 22 years, were investigated. Whereas anti-HCV was investigated with third generation immunoenzymatic test and confirmed by HCV-RNA, LiPA technique determined genotypes. HCV-prevalence infection reached 37.7% and 21.7% respectively when antibody anti-HCV and HCV-RNA detection and associated significantly (p<0.05) with type of treatment, date of start of treatment and ALT and AST hepatic enzyme rates are taken into account. HCV genotype 1 predominated (53.3%) followed by genotype 3 (40.0%) and genotype 2 (6.7%). HCV predominance is high in haemophilic patients although infection has not been reported in patients under the age of 17.

Prevalence of serological markers of hepatitis B virus in pregnant women from Paraná State, Brazil.

The prevalence of hepatitis B virus (HBV) in Brazil increases from South to North but moderate to elevated prevalence has been detected in the Southwest of Paraná State. The prevalence of serological markers of HBV was evaluated in 3188 pregnant women from different counties in Paraná State and relevant epidemiological features were described. The prevalence of HBV markers in pregnant women for the state as a whole was 18.5% (95% CI = 17.2-19.9), ranging from 7.2% in Curitiba to 38.5% in Francisco Beltrão. The endemicity of HBV marker prevalence in pregnant women was intermediate in Cascavel, Foz do Iguaçu, and Francisco Beltrão, and low in Curitiba, Londrina, Maringá, and Paranaguá. Multiple logistic regression showed that HBV marker prevalence increased with age, was higher among black women, among women of Italian and German descent, and among women who had family members in neighboring Rio Grande do Sul State. Univariate analysis showed that HBV marker prevalence was also higher among women with no education or only primary education, with a lower family income and whose families originated from the South Region of Brazil. Pregnant women not having positive HBV markers (anti-HBc, HBsAg or anti-HBs detected by ELISA) corresponded to 73.7% of the population studied, implying that HBV vaccination needs to be reinforced in Paraná State. The highest prevalence was found in three counties that received the largest number of families from Santa Catarina and Rio Grande do Sul, where most immigrants were of German or Italian ascendance. This finding probably indicates that immigrants that came to this area brought HBV infection to Southwestern Paraná State.

Prevalence of serological markers of hepatitis B virus in pregnant women from Paraná State, Brazil

The prevalence of hepatitis B virus (HBV) in Brazil increases from South to North but moderate to elevated prevalence has been detected in the Southwest of Paraná State. The prevalence of serological markers of HBV was evaluated in 3188 pregnant women from different counties in Paraná State and relevant epidemiological features were described. The prevalence of HBV markers in pregnant women for the state as a whole was 18.5 percent (95 percent CI = 17.2-19.9), ranging from 7.2 percent in Curitiba to 38.5 percent in Francisco Beltrão. The endemicity of HBV marker prevalence in pregnant women was intermediate in Cascavel, Foz do Iguaçu, and Francisco Beltrão, and low in Curitiba, Londrina, Maringá, and Paranaguá. Multiple logistic regression showed that HBV marker prevalence increased with age, was higher among black women, among women of Italian and German descent, and among women who had family members in neighboring Rio Grande do Sul State. Univariate analysis showed that HBV marker prevalence was also higher among women with no education or only primary education, with a lower family income and whose families originated from the South Region of Brazil. Pregnant women not having positive HBV markers (anti-HBc, HBsAg or anti-HBs detected by ELISA) corresponded to 73.7 percent of the population studied, implying that HBV vaccination needs to be reinforced in Paraná State. The highest prevalence was found in three counties that received the largest number of families from Santa Catarina and Rio Grande do Sul, where most immigrants were of German or Italian ascendance. This finding probably indicates that immigrants that came to this area brought HBV infection to Southwestern Paraná State.

[The laboratory diagnosis and epidemiology of cutaneous leishmaniasis in Paraná State, southern Brazil]. / Observações sobre o diagnóstico laboratorial e a epidemiologia da leishmaniose tegumentar no Estado do Paraná, sul do Brasil.

Between 1986 and 1997 a total of 1418 patients were examined at the Clinical Analysis Teaching and Research Laboratory of Maringá State University (LEPAC/UEM) for cutaneous leishmaniasis by direct examination of stained smears made from the lesions, the Montenegro skin test and the indirect immunofluorescent antibody test. Nine hundred and fifty five patients (67.3%) were positive for at least one of the three tests and of these 804 (84.2%) were considered to have contracted the disease in Paraná State; 665 (69.6%) were between 15 and 49 years old; 658 (68.9%) were males; 523 (54.8%) sought medical advice during the first three months of their infections and 74 (7.7%) had mucosal lesions. Of the 83 counties of Paraná State, where the patients had most probably acquired their infections, 44.7% were from the counties of São Jorge do Ivaí (10.2%), Doutor Camargo (9.8%), Terra Boa (7.3%), Maringá (7.3%), Jussara (6.0%) and Cianorte (4.5%). Seventy seven strains of Leishmania (Viannia) braziliensis were isolated and 63.6% of these strains belong to serodema 1.

[Frequency of anti-Cysticercus cellulosae antibodies in individuals from five counties in the Northern region of Brazil]. / Freqüência de anticorpos anti-Cysticercus cellulosae em indivíduos de cinco municípios da região Norte do Estado do Paraná-Brasil.

An epidemiological and serological study was carried out on a sample of 2,180 individuals, in five counties in the north of Paraná State-Brazil, using the indirect immunofluorescence test to detect anti-Cysticercus cellulosae antibodies. These individuals, 69 (3.2%) showed significant titers of antibodies. No single significant difference between the proportion of reactivity in Sarandi (6.6%) and in Marialva (4.7%) was observed (Z = 1,319, P = 0.0936), but it was significantly higher than that observed in Mandaguaçu, Paiçandu and Maringá (P < 0.01). Of these individuals, 47.9% were within 21-49 years old and 79.4% were of female sex. "Headache" (70.6%), "faintness" (57.4%), and "convulsions" (7.4%) were among the most frequent by reported, moreover, cases of Taenia infections (22.1%) and the custom of eating uncooked beef (41.2%) or pork (27.9%) and meat containing cysticerci (25.0%) were also related.